New book - Why Physicians die by Suicide by Dr Michael Myers

Dr Michael Myers is a U.S. psychiatrist who specialises in physician health. His most recent book has just been published Why Physicians die by Suicide.

Dr Myers has kindly provided an extract from the introduction below:

'……. as a practicing clinician treating physicians and their families and as an academician, I have spent my entire career studying the tragedy and enigma of suicide among doctors. Despite substantial research into the personal and workplace stressors, personality traits, psychological vulnerabilities, and psychiatric illnesses among doctors, the published literature is short on information gleaned from those who know physicians best – their family members, medical colleagues, and intimate friends, their teachers and students, as well as those who have lost their physicians to suicide. I have long believed that these are exactly the people who hold information that is key to our quest to make sense of why some doctors make such a desperate decision about their life.

For more than two years I have been talking with those who are willing to share their story and understanding of the physician loved one, colleague/friend, or treating doctor whom they’ve lost. In the pages that follow, you will hear their voices, and I will share what I have learned from them, as well as from another, equally significant population--physicians (including some of my own patients) who have attempted suicide and did not die. They are able to provide unique and invaluable information about the ideas and emotions that led to their decision to kill themselves as well as the ways in which their near-death experience and second chance at living have fundamentally changed them.

Although suicide has been with us since the beginning of time, it remains a very taboo subject in our society. Many people do not want to know about it and when they do they want to push it way, to forget about it, trying hard not to remember. I am only too aware of this. I sense it when I face the resistance to my research or the derision I get from a few of my colleagues about “being obsessed with suicide”. We write about very different subjects but I feel great kinship with the late Elie Wiesel. In accepting the Nobel Peace Prize in 1986, he said, “…I have tried to keep memory alive…I have tried to fight those who would forget. Because, if we forget, we are guilty, we are accomplices.”

As painful as suicide is, we must remember our brothers and sisters in medicine who could not go on, whose lives were so tragically interrupted. Many of the people with whom I spoke in preparation for writing this book have told me that they were sharing their stories because they didn’t want their loved one to have died in vain, and they hoped what they had to say would in some way contribute to saving the life of another despairing physician.

In the words of Dr. Edwin Shneidman who was a Professor of Psychology at UCLA, esteemed researcher, prolific author and giant in the study of suicide: “Postvention is prevention for the next generation.”

So
could it cover feeling a journalist’s knees under the table? Oh yes,
absolutely.

Second,
the conduct must be *”unwanted”* conduct. If the journo is happy to have her
knees touched, it’s not harassment. But there’s more, the conduct must have the purpose OR the effect of: 1.
Violating the victim’s dignity; or 2. creating an intimidating, hostile,
degrading, humiliating or offensive environment for them .. Note,
purpose OR effect. So if you are trying to violate their dignity you don’t need
to succeed to be in trouble.

Equally,
if you create a hostile environment you don’t escape merely because that was
not your purpose.

When
considering whether the conduct has had one of the two effects mentioned above,
the tribunal must look at 3 things: 1.
the victim’s perception; 2. the other circs of the case; and 3. whether it is
reasonable for the conduct to have the effect. So
if someone is irrationally over-sensitive that will not count but it's the
victim’s perception and not the harasser’s that counts

So,
for instance, the fact that you can’t see why a journo would object to having
their knee squeezed is not important. If
it is something a reasonable person could find intimidating or degrading, for
eg, that may well do. Also,
victim’s perceptions may reasonably differ, so the fact that one finds it
trivial does not mean all will.

The
standard is not that of the hardiest victim.

Harassment “It was different 15 to 20 years ago”.

I don’t
understand this argument. Assume
that the statement is true. So what? A lot of social attitudes have changed in
the last 15 - 20 years. Have
these people been on the moon? Did they not notice the huge social change they
claim has occurred? However,
I’ve been dealing with sexual harassment in the workplace cases for some 26
years. I don’t think things are radically different now

The
current legal definition is an evolution of the one contained in the EU
Commission recommendation on sexual harassment from 1991. It
was quickly adopted by UK tribunals and applied in harassment cases (which were
then treated as a species of direct discrimination). There
might be cases that would be unlawful under the present test that would not
have been then, but I struggle to think of one. Workplaces
were not Carry On fantasies with women giggling uncontrollably at a stream of
lewd double entendres.

Being
the subject of humiliating or degrading treatment was no less destructive of
people’s dignity in 1990 than it is now.

We should not
confuse inability effectively to challenge behaviour with tacit approval.'

It seems that recovery from mental illness is not enough. Well that’s the impression I get from our stigma filled world. It was really bad when I was suffering from depression – when you have a low self-esteem as a result of your brain chemistry, then often those who you know well, like family & friends unwittingly betray their ignorance with ill thought out advice or banal platitudes. Most of us try to do the right thing and seek advice from our GP and/or various other health professionals. Even then we cannot guarantee that we will be treated with the dignity and respect that we deserve. I was fortunate in that respect most of the time during my illness, with the exception of some of the nursing staff during my inpatient stays and of course the various different specialities that I had the misfortune to come across after bouts of self-harm.

But all that was years ago and I have been well, apart from a less serious relapse which led to me taking antidepressants for life. I have now been completely well for the best part of ten years. That is - well in terms of my mental health.

Delay in diagnosis of appendicitis due to mental health history

Unfortunately, physically I haven’t been so lucky. I have needed various surgeries and medical treatment completely unrelated to my previous psychiatric history. Take for example the time when I suffered from an acute appendicitis. So, having had classic crampy abdominal pain for 36 hours, I am then woken suddenly at 03.00 am with severe right sided lower abdominal pain. By morning, I manage to get an emergency appointment with my General Practitioner (GP). Well, I say my GP, but the truth is that he is a GP at the practice where I am registered and I think it’s no coincidence that he is available. He is always available and perhaps here’s why. So, I come in and explain my symptoms and as if by magic, his first thought is “Could this be a touch of Irritable bowel?” Well, I know someone put this diagnosis on my notes nearly thirty years ago when I had diarrhoea for several months. The fact that it all cleared up and I had none of the other symptoms, not have I ever complained of anything similar since, rather suggests to me, that this was an inaccurate diagnosis.

But of course, why consider something physical in a 55 year old who has had a past history of depression? Despite doing my best to avoid having to go to Accident & Emergency (A&E) where I was working, by the time I drove home, I realised that I was not going to be able to drive any more that day. I waited until my husband got home from work, which meant a call to the out-of-hours service. Unfortunately, they wouldn’t see me, so I ended up being admitted from A&E. I was septic by the time I had my appendectomy the following day, but no further mention of my past history had been made or so I thought.

Medical record error correction – or not

I
have a scar from a mini abdominoplasty performed several years after the dreadful depression from 1994-2001, when I was in a psychotic state and repeatedly cut myself. The procedure was to remove scar tissue that had become problematic after my self-mutilation. I almost bled to death from one of those episodes, so being the fool that I am, when asked by the surgical Foundation Year 2 doctor why I had the scar, I told the truth. I find out several weeks later that she has requested a CT scan stating I have a ‘self-inflicted wound’. This request is seen by those who I work with on a daily basis and not only is it totally untrue – I have a scar from an abdominoplasty- but it is there, indelible on my record. I tried to get it changed, but it cannot be deleted – a note was put that this was false, eventually, but only after I persisted, having first been threatened with the possibility of disciplinary action for viewing my own CT scan!

Sjögren's syndrome / anxiety – discuss!

I had the misfortune to meet the same GP over a year later, this time when I had been referred to him, from my dentist suspecting Sjögren's syndrome. I have dry eyes, mouth ulcers and sores as a result of the dry mouth and his diagnosis this time is anxiety, because he gets a dry mouth when he’s anxious! I have to instruct him on what blood tests need to be requested. There follows a whole series of consultations with maxillofacial surgery for a biopsy and rheumatology. I also contact the psychiatrist who I was seeing to get him to put in writing that my symptoms are not psychogenic. He also asks if they would please do the decent thing and do proper investigations. It all ended badly, with a doctor being incredibly rude to me. My complaint is dealt with in a similar incompetent manner and seven months later, I receive the answer to it, where the doctor in question has fabricated a story accusing me of forcing her to do the biopsy. Of course, the whole tone of the letter is far from apologetic. Instead, I feel as if I did something wrong by just being a patient. By the time I received this, I am in the USA, having emigrated to Denver, Colorado. Thankfully here no one has questioned the validity of my symptoms and I am receiving appropriate treatment for Sjögren's syndrome, but at a cost!

Practising as a doctor with a mental health history in the USA

Sadly, though the US also takes a dim view of those who have had mental health problems. You can be refused entry to the country if you have self-harmed in the past and are deemed likely to repeat this in the future. While studying for the United States Medical Licensing Exam (USMLE), I found out that if you are suffering from depression and see a doctor when you are working, you have no right of confidentiality and you are not allowed to work, regardless of whether or not you are performing well or have no potential safety issues………………Apparently, in Texas, you will not be able to gain a licence to practice at all, if you have had a history of mental health problems.

Of course, my attempt to get life insurance a few years ago when I was still working in the UK was also thwarted. My GP stated that although I had been well for years, in the past I had self-harmed on multiple occasions – it was true, but that’s it – my life wouldn’t be covered if I committed suicide – well of course not, but in fact my life cannot be covered at all. It was refused and that’s the end of it!

Future plans

This sounds rather depressing, doesn’t it? There is still a long way to go to eliminate not only the stigma of current mental illness, but also of the past. It does fill me with sadness and it also makes me feel angry. But I don’t want to become bitter and unforgiving. While I worked in A&E until August last year, I did my utmost to be open about myself and to educate my colleagues. We are whole people, the mind and body are not separate entities and we all deserve respect and care regardless of our past or present symptoms, or what brought them about. But changing attitudes takes more time than I first thought.

I have not pursued the complaint. It devoured emotional energy and although the head of the complaints department suggested that I enlist the help of a solicitor, it is not such an easy thing to do from here. But I am in two minds. Will the NHS only listen if litigation occurs? If so then maybe it’s worth it, but I don’t want to deprive an already overstretched system of precious resources. At the same time, it does worry me. I am articulate and a doctor and this happens to me, so what about those who are less able to speak for themselves? Sadly, I am increasingly of the mind that I should record consultations, because for some reason, I seem to be the loser when it comes down to who said what. From a legal point of view, a patient is at liberty to do so, even if they do not divulge the information. From a doctor’s stance, I think it would be good if everyone assumed that whatever we say was being recorded. It may just help the vulnerable to not be taken advantage of.

I hate to admit it, but I am still vulnerable as a result of what happened to me in the past. None of it was my fault, I never chose to be ill and I did my best to get free from it. Unfortunately, it follows me, but now, as much as ever, I wish to put the experience to good use to help others. I am far from perfect, but I hope that someone, somewhere will give me a chance. At present, I remain unemployed, hoping, looking and waiting for opportunities here in the USA. Pray or wish me luck, it looks like I need it!

Dr Cathy Wield

Author of Life After Darkness: a doctor’s journey through severe depression
2006 and A Thorn In My Mind: mental illness, stigma and the church
2012

The initial suggestion for this collaboration came from Dr Astrid Freisen of Selbst betroffene Profis
- a group for health professionals with bipolar which is associated with the German bipolar society Deutsche Gesellschaft für Bipolare Störungen
. Astrid contacted DSN by email and suggested that we propose a joint symposium for the World Psychiatry Association Congress due to be held in Berlin from 8-12th October 2017. Bearing in mind that our discussion was entirely carried out online and that we did not meet in person until the day before the symposium, our arrangements including agreeing the symposium titles, content and abstract were extremely practical and straightforwards.

Fiona is a Consultant in Public Health Medicine with 25 years experience in wellbeing and resilience who is also a fully qualified 'Executive Coach'. Read on to find out how to choose the right coach for you.

Imagine someone who is on your side, walking every step of your career journey alongside you, with no other agenda other than to support you to understand yourself and to make the best decisions you can make, whether you need to make major or minor career changes, improve your wellbeing at work, or develop your skills further. Someone who can challenge you when you contradict yourself in a way which brings out your deeper sense of purpose and helps you to learn and grow in your career and working life, and views you and your career from a perspective of believing in your potential. Sounds too good to be true? Many senior professionals, and most executives, now work with an Executive Career Coach to support them in their career, usually on and off over years or decades, based on adult to adult relationships founded on trust, honesty and integrity.

All Executive Coaches bring some core skills and qualities to their coaching relationships, with nuances according to their own style and their background. It’s important to find the right match for yourself and your own needs – too similar to you and will they challenge you enough? Too different and will they be able to understand your context? This article will help you to find the sweet spot – finding the right Executive Coach to support you in your own career.

1. Is this the right time for you?
Coaching can be demanding as well as fun and exciting, it is a journey which will reveal what matters most to you in your life and your career. You become ‘more yourself’ as you learn more about yourself and start to make the changes you need to bring yourself greater meaning and purpose in your life. If you are unwell, check with your healthcare professional first before starting on career coaching – working out the next steps in your career can be key to your recovery and may be positively helpful, or it may not be the right time for you. When working with an Executive Coach, you will have a mixture of session time (face to face or by remote video such as skype) and actions to take away between sessions to implement. This means you need both time for the sessions (these are usually 1.5-2 hours every 4 weeks or so, for 3-4 sessions depending on your needs) and you will need some time between sessions to complete any actions. All actions are always invitations and will be codesigned with you to help you to create space in your life so that you can make the changes you need and to help you to ‘clear the decks’ so that you have more time for what matters most to you.

2. Finding the right coach.
There are a growing number of people who call themselves career (and ‘life’) coaches so you might want to check their qualifications and experience. The NHS generally expects their internal coaches to have as a minimum the ILM5 coaching qualification, with more senior staff using Executive Coaches (ILM7). In terms of experience, you might like to check for experience of working with people with the kind of goals you would want to set. You might want to check the coach has the right kind of background for you so that they can understand your context. Other things to look out for: what theoretical model do they use; who is their supervisor and how often do they have supervision; what CPD have they undertaken recently; are they registered as a Data Controller with the Information Commissioner’s Office and how is your information and confidentiality protected? Are they a member of any coaching professional bodies such as the European Mentoring and Coaching Council, and any coaching networks? What has been their own career journey? Some people find it helpful to make a checklist of what they are looking for in a coach before they speak to anyone so they can be clear what they are looking for in advance.

3. Making contact.
Most Executive Coaches will offer you a free consultation session to have a confidential but no obligation chat about what you are looking for and whether they can help you at this time. They will be checking that this is going to be right for you as well as for them. This is a great opportunity to find out if the ‘chemistry’ works between you, is this someone you feel you can trust with your deepest hopes and fears with your career? It is similar to finding a therapist, though coaching is not therapy, counselling or advice giving, rather it is focused on the future and on your working life. Check on their fees and whether there are any hidden costs such as VAT.

4. The coaching contract.
Coaching works within a contracted relationship. The contract essentially covers ‘this is what you can expect from me and this is what I expect from you’, this is part of it being an adult to adult relationship. The coach helps you to identify your own coaching goals at the start of a coaching relationship and the contract states the boundaries that you work within. You might like to ask for a draft copy of the coaching contract and check it has everything you need in it for you to feel comfortable within the relationship.

5. Getting started.
Most of my clients are apprehensive about what to expect especially if they have never been in a coaching relationship before. This is normal and your coach will probably give you some exercises to do before the first session to help you get into a reflective and action planning mode. Coaching is about helping you to work out what you want in the future, and how to move step by step towards that on a daily basis.

We are all going to live longer and spend more of our lives at work. This may or may not be within medicine as our career choice or option. If your career isn’t right for you for whatever reason, take the time to work out who you are and what matters most to you, and set up the next phase of your working life in a way which will bring you meaning, purpose and satisfaction. It’s an investment in yourself and your future that you won’t regret!

'……. as a practicing clinician treating physicians and their families and as an academician, I have spent my entire career studying the tragedy and enigma of suicide among doctors. Despite substantial research into the personal and workplace stressors, personality traits, psychological vulnerabilities, and psychiatric illnesses among doctors, the published literature is short on information gleaned from those who know physicians best – their family members, medical colleagues, and intimate friends, their teachers and students, as well as those who have lost their physicians to suicide. I have long believed that these are exactly the people who hold information that is key to our quest to make sense of why some doctors make such a desperate decision about their life.

For more than two years I have been talking with those who are willing to share their story and understanding of the physician loved one, colleague/friend, or treating doctor whom they’ve lost. In the pages that follow, you will hear their voices, and I will share what I have learned from them, as well as from another, equally significant population--physicians (including some of my own patients) who have attempted suicide and did not die. They are able to provide unique and invaluable information about the ideas and emotions that led to their decision to kill themselves as well as the ways in which their near-death experience and second chance at living have fundamentally changed them.

Although suicide has been with us since the beginning of time, it remains a very taboo subject in our society. Many people do not want to know about it and when they do they want to push it way, to forget about it, trying hard not to remember. I am only too aware of this. I sense it when I face the resistance to my research or the derision I get from a few of my colleagues about “being obsessed with suicide”. We write about very different subjects but I feel great kinship with the late Elie Wiesel. In accepting the Nobel Peace Prize in 1986, he said, “…I have tried to keep memory alive…I have tried to fight those who would forget. Because, if we forget, we are guilty, we are accomplices.”

As painful as suicide is, we must remember our brothers and sisters in medicine who could not go on, whose lives were so tragically interrupted. Many of the people with whom I spoke in preparation for writing this book have told me that they were sharing their stories because they didn’t want their loved one to have died in vain, and they hoped what they had to say would in some way contribute to saving the life of another despairing physician.

In the words of Dr. Edwin Shneidman who was a Professor of Psychology at UCLA, esteemed researcher, prolific author and giant in the study of suicide: “Postvention is prevention for the next generation.”

Why does DSN need a blog?
Our blog page will be a place to collect new stories and articles on our website, which can be linked to social media and elsewhere. Blogs also help to increase recognition of the website by search engines.What type of story is suitable for the DSN blog?
The blog will contain a mix of stories about DSN's activities and physician health in general.Can DSN members / friends contribute an article for the blog?
Yes of course. A good blog feature article would be approximately 300 words in length and have a couple of clear (non copyright) photos to illustrate it. If you are not sure whether your idea would fit the DSN blog, then ask us via info@dsn.org.uk. Contributions will be edited to house style and published to fit in with our schedule if the article is deemed to be suitable for DSN.

DSN Mailing List

Please complete the form below if you would like to receive occasional updates about DSN by email.

N.B. We use our newsletter to communicate with our contacts so you need to allow receipt of the newsletter in order to remain in contact with DSN.

Follow us

DisclaimerAll opinions expressed on this website are those of the individual authors and do not necessarily reflect an official position of DSN. DSN cannot accept responsibility for any actions taken as a result of content of the website. Links to other organisations are provided for information only and are not a recommendation. In particular, you may want to check about confidentiality when contacting other organisations.